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Confidential clinician-reported surveillance of adverse events among medical inpatients
S N Weingart1, A N Ship, M D Aronson
1Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, and Department of Medicine, Harvard Medical School, Boston, MA 02215, USA. sweingar@caregroup.harvard.edu
Background:
Although iatrogenic injury poses a significant risk to hospitalized patients, detection of adverse events (AEs) is costly and difficult.
Methods:
The authors developed a confidential reporting method for detecting AEs on a medicine unit of a teaching hospital. Adverse events were defined as patient injuries. Potential adverse events (PAEs) represented errors that could have, but did not result in harm. Investigators interviewed house officers during morning rounds and by e-mail, asking them to identify obstacles to high quality care and iatrogenic injuries. They compared house officer reports with hospital incident reports and patients' medical records. A multivariate regression model identified correlates of reporting.
Results:
One hundred ten events occurred, affecting 84 patients. Queries by e-mail (incidence rate ratio [IRR] = 0.16; 95% confidence interval [95% CI], 0.05 to 0.49) and on days when house officers rotated to a new service (IRR = 0.12; 95% CI, 0.02 to 0.91) resulted in fewer reports. The most commonly reported process of care problems were inadequate evaluation of the patient (16.4%), failure to monitor or follow up (12.7%), and failure of the laboratory to perform a test (12.7%). Respondents identified 29 (26. 4%) AEs, 52 (47.3%) PAEs, and 29 (26.4%) other house officer-identified quality problems. An AE occurred in 2.6% of admissions. The hospital incident reporting system detected only one house officer-reported event. Chart review corroborated 72.9% of events.
Conclusions:
House officers detect many AEs among inpatients. Confidential peer interviews of front-line providers is a promising method for identifying medical errors and substandard quality.
Insights
House officers can identify many adverse events (AEs) and potential adverse events (PAEs) through confidential peer interviews. This method is more effective than traditional incident reporting for detecting medical errors and improving patient safety.
Area of Science:
- Patient Safety
- Medical Error Detection
- Healthcare Quality Improvement
Background:
- Iatrogenic injury is a significant risk for hospitalized patients.
- Detecting adverse events (AEs) is challenging and resource-intensive.
- Existing reporting systems often fail to capture the full scope of medical errors.
Purpose of the Study:
- To develop and evaluate a confidential reporting method for detecting AEs and potential adverse events (PAEs) on a hospital medicine unit.
- To compare the effectiveness of this method against traditional hospital incident reporting.
- To identify common causes of medical errors and substandard care.
Main Methods:
- A confidential reporting system using interviews with house officers (physicians-in-training) was implemented.
- House officers were interviewed about obstacles to care and iatrogenic injuries.
- Reports were compared with hospital incident reports and medical records; a regression model identified reporting correlates.
Main Results:
- 110 events affecting 84 patients were identified.
- Confidential interviews identified significantly more AEs and PAEs than the hospital incident reporting system.
- Commonly reported issues included inadequate patient evaluation and failure to monitor or follow up.
- Chart review corroborated over 70% of reported events.
Conclusions:
- House officers are a valuable source for identifying AEs in inpatients.
- Confidential peer interviews represent a promising strategy for uncovering medical errors and improving healthcare quality.
- This method offers a more sensitive approach to patient safety surveillance.
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